摘要
腹部手术后出现的复杂性腹腔感染(complicated intra-abdominal infections,cIAI)是临床常见但处理棘手的难题,需要选择合适的感染源控制手段,并合理使用抗菌药物进行治疗。针对cIAI感染源的治疗,需要贯彻损伤控制理念并建立阶梯式处理方案,首选微创改善引流或建立引流途径,可使用CT或超声导引的经皮经Trocar放置黎氏双套管冲洗引流;对于单纯改善引流无法控制感染源时则应行开腹引流;对于合并有腹腔高压的腹腔感染病人应行腹腔开放疗法。cIAI早期应根据科室致病菌流行特点选择经验性治疗用药,对于重症感染病人推荐降阶梯疗法,一旦细菌培养结果和药敏试验结果明确,则应调整抗生素。
Postoperative complicated intra-abdominal infec- tions （cIAIs） are common but challenges in clinical practice, which need adequate source control procedure and antimicro- bial therapy. Damage control and step-up approach should be set up during source control procedure of cIAls. Initial mini- mally invasive intra-abdominal drainage like percutaneous drainage using a sump drain by trocar puncture should be per- formed. If minimally invasive drainage can＇t control infection, surgical drainage should be administrated. If complicated with abdominal hypertension, open abdomen should be taken into consideration. Empiric antimicrobial therapy should be initiat- ed once a patient receives a diagnosis of an intra-abdominal infection according to epidemiological feature, followed by pathogen-directed antimicrobial therapy.
出处
《中国实用外科杂志》
CSCD
北大核心
2014年第2期137-140,共4页
Chinese Journal of Practical Surgery
关键词
围手术期
复杂性腹腔感染
感染源控制
损伤控制
阶梯式处理
perioperative period
complicated intra-abdomi- nal infections
source control procedure
damage control
step-up approach
